Chicken Pox (varicella)

Chicken pox is a common childhood illness that is very contagious. It is caused by a virus that is spread by airborne droplets (from coughing and sneezing) or direct contact. A child can get chicken pox if exposed to someone with shingles and they have not previously had chicken pox or been vaccinated. The disease is on the decline since the routine vaccination for the virus has been recommended. Most children are now vaccinated at around one year of age. If your child has not previously had chicken pox disease or the vaccination call your doctor to discuss getting your child protected.

How can you tell if it is chicken pox?

We commonly see patients in the clinic with that very question. Many, many rashes are commonly confused with chicken pox. What is distinctive about the rash of chicken pox is the small blister sitting on red blotch. Often described as a “dew drop on a rose petal”. The blister is not evident immediately but should be seen within the first few days. Also, lesions pop up at different times showing different “ages”. In other words, as the above picture shows, some lesions will not yet have the blister, some will, and some will be scabbing over. The water blisters are filled with varicella virus. Until all lesions are scabbed over, chicken pox can be transmitted toÂ vulnerableÂ individuals.

When to call

If child seems very ill and has: vomiting, confusion, convulsions, increased sleepiness, poor balance, stiff neck, or breathing problems (CALL RIGHT AWAY)
Temperature over 102Â°
If areas of rash become very red, warm, and painful
If scabs get a red ring, and drain pus
“Giant” pox spot (greater than the size of a half dollar coin) could be a sign of secondary bacterial infection
If child is younger than 1 month
Child has eye pain and constant blinking

What to expect

An incubation period of about 14 days (range 10-23 days)
There may be some malaise and fever 1-2 days before itchy rash
Rash usually goes through these stages in about 24 hours: (1) Small red bumps (not always seen) soon change to (2) Small blisters (may have red ring around them) then (3) Cloudy blisters (or open sores/usually less than 1/4”) (4) Next, dry, brown crusts, or scabs. Crusts may last 1â��2 weeks before falling off.
New “crops” of spots keep coming (for about 4-5 days) (child will have spots in various stages at one time)
Contagious one or two days before rash and until all spots are scabbed over
The rash usually starts on scalp and face, then spreads to trunk; usually there are more spots on trunk and face, fewer on arms and legs.
Child may get sores in their mouth, throat, nose, and genital area
Fever (the higher the fever, the more prevalent the rash tends to be)

What to do

Acetaminophen (TylenolÂ©) for pain, fever
Absolutely NO ASPIRIN
Lukewarm baths (every 3-4 hrs.)
Oatmeal bath (non-prescription) can help with itch
Bathe daily with soap and water (prevent infection)
Keep fingernails trimmed short
Calamine lotion on itchy spots helps (no CaladrylÂ© since it contains benadryl)
BenadrylÂ© elixir (non-prescription) can be used for itching (swallow medicine, not cream on skin)
Do not use topical (on the skin) BenadrylÂ©
Ice: massaging itchy spots with ice for 10 minutes often helps
Cover baby’s hands with cotton socks (prevent scratching)
Sore mouth: encourage cool liquids, use soft, bland diet (avoid salty foods, citrus fruits)
Acyclovir is an antiviral medication that can benefit a few select patients that are either very young or have severe underlying medical conditions putting them at risk for severe complications of chicken pox. Medication must be given early in illness for benefit.

Prevention

A vaccine is available for chicken pox which is very effective
PEDIATRICIANS ADVISE that CHILDREN should RECEIVE THE VACCINE
If your child is not adequately protected and is exposed to varicella, prompt vaccination can reduce risk of acquiring the infection. Discuss with your doctor, even if your child is not yet “due” for the next dose in the series, but was recently exposed.
In 2006 a second varicella injection is now recommended for any child who has never had chicken pox infection. Typically this dose is given with the 4-5 year shots just prior to entry to kindergarten. If a child is older than the second dose can be given at any time.
All healthy children can receive the vaccine if older than 12 months of age.

Shingles

Shingles (also called Varicella Zoster) is the reactivation of the chicken pox virus. Once a person has been infected with chicken pox they continue to carry the virus in some spinal cord nerves for the rest of their lives. Periodically this can cause inflammation/irritation in the nerve causing itching and pain sensations. Skin lesions are seen in the distribution of the particular nerve root. In other words, the lesions are seen most often on the side or back of trunk, only on one side in a space of a few inches. Rarely can involve neck, ear or side of face. Fortunately for kids it is a benign illness. Systemic symptoms are very unusual. While there is a small amount of virus in the lesions spreading the virus from person to person is unusual. Typically keeping lesions covered with clothing is enough to reduce risk of spread. Caution is recommended in persons with underlying serious medical problems or those with contact with people with underlying medical problems (especially the elderly and those with reduced immune systems). Recently a new vaccine was approved for the elderly to directly reduce the risk of shingles.

Shingles after vaccine is possible but occurs LESS often than after wild virus infection.

More Information

CDC Varicella information (disease and vaccine)
Web MD discussing Chicken Pox
Description of chicken pox lesions